In this episode of the Psychedelic Medicine Podcast, Arsalan Azam, MD joins to unpack the intersection between psychedelics and GLP-1s. Dr. Azam, founder of Daydream MD, completed his residency in Emergency Medicine at the Metropolitan/Harlem Emergency Medicine Residency program in New York before practicing emergency medicine nationwide. Drawing on that experience, he developed a comprehensive ketamine-assisted therapy practice and now blends functional medicine with personalized GLP-1 services to help patients achieve sustainable, biologically tailored health outcomes.

In this conversation, Dr. Azam explores the emerging intersection of GLP-1 medications and psychedelic therapies, arguing that both create temporary windows for behavioral change that can be leveraged to improve long-term mental and metabolic health. He explains how GLP-1 medications act primarily on the brain's reward and craving circuits, reducing "food noise" while creating opportunities to reshape habits and addictive behaviors. The discussion also covers how GLP-1s may complement psychedelic-assisted therapies for conditions such as addiction and PTSD, potential interactions with ketamine and classic psychedelics, and important clinical considerations, including nausea, delayed gastric emptying, medication dosing, and the importance of individualized treatment strategies.

In this episode, you'll hear:

• How GLP-1 medications influence the brain's reward, craving, and motivation circuits
• Why Dr. Azam views GLP-1s and psychedelics as complementary therapies that each create windows for lasting behavioral change
• The potential role of GLP-1 medications in treating addiction alongside psychedelic-assisted psychotherapy
• What patients and clinicians should know about combining GLP-1 medications with ketamine and classic psychedelics
• How delayed gastric emptying may alter the timing, intensity, and safety of orally administered psychedelic experiences
• Why careful dosing of GLP-1 medications is important to avoid emotional blunting while preserving their therapeutic benefits
• The importance of using both psychedelic and metabolic therapies as opportunities to build healthier long-term habits rather than relying on medication alone

Quotes:

"Not all behavioral health symptoms are driven purely by things going on in the brain and the nervous system and mood and whatnot. Sometimes it's well outside that. And so that's where, naturally, GLP-1s caught our gaze. Here's a medicine that treats probably one of the biggest of the two health crises I think right now facing America: one is—I do think—mental health, but the other is metabolic health." [4:52]

"Just like psychedelics create a window [of transformation], GLP-1s create a window. It's this pharmacologic scaffolding that you can use to start to really reexamine your relationship with food, with craving, how you've been eating, why you've been eating. And you can essentially use GLP-1s to hit the pause button on that noise, and that makes it easier to eat less. But it also makes it easier to start to ask the questions of why? Why was I eating the way I was eating?" [9:59]

"In general, GLP-1s seem to play pretty nicely [with ketamine]. I'd say the bigger thing that I've observed that doesn't get named all that much is that craving and reward are important. They're part of how we see salience in the world and also derive pleasure from it, and if you go too high on a GLP-1, people experience a flattening. They feel kind of blah, and it's not in their head. It's because you've over-damped the salience and reward circuitry. And so it's about finding the sweet spot where there's enough to motivate you in life without being noisy." [20:13]

Links:

Daydream MD website

Daydream MD on Instagram

Daydream MD on Facebook

Dr. Azam on LinkedIn

Psychedelic Medicine Association webinar: GLP-1s and Psychedelics: Clinical Considerations, Interactions, and Emerging Questions

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In this episode of the Psychedelic Medicine Podcast, Dori Lewis, MA, MEd, LPC-S returns to discuss the differences between psilocybin and ketamine. Dori is the Clinical Director of Elemental Psychedelics and Owner/Operator of Reflective Healing in Fort Collins Colorado. As a clinician, she blends transpersonal psychology, depth work, and psychedelic-assisted therapy within a model that centers the therapeutic relationship. To date, she has stewarded over 100 ketamine therapy sessions, more than 200 mushroom sessions, and numerous group ceremonies.

In this conversation, Dori explores how clinicians and facilitators can thoughtfully decide when ketamine or psilocybin may be the more appropriate therapeutic option, emphasizing that the two medicines are complementary rather than competing approaches. She explains how factors such as current medications, trauma history, substance use, prior experience with altered states, therapeutic readiness, and available social support all shape this decision. Throughout the discussion, Dori argues that ketamine often serves as an accessible and effective introduction to psychedelic-assisted therapy, while psilocybin may be especially valuable for addressing grief, attachment and religious trauma, and deeper existential questions when paired with sufficient preparation, integration, and a strong therapeutic relationship.

In this episode, you'll hear:

• Why ketamine is often recommended before psilocybin for people new to psychedelic therapy
• How SSRIs and other medications influence the choice between ketamine and psilocybin
• What personal history, symptoms, and therapeutic readiness clinicians should evaluate before recommending either medicine
• Which conditions and life experiences may be particularly well-suited for psilocybin-assisted therapy, including grief, attachment trauma, and existential distress
• How cannabis use, substance use disorders, and suicidal ideation can affect treatment planning
• Why community support, integration resources, and a trusting relationship with a facilitator are critical for successful psychedelic experiences
• The importance of cultivating self-awareness before engaging in psychedelic-assisted therapy

Quotes:

"How do we help somebody who is on these [SSRI] medications, has been on them for a really long time and is actually doing well with them? The answer is not to get someone to stop taking their meds just to have a psilocybin experience. That's actually really reckless, in my opinion. What I would say is, why don't we start with ketamine and see how that affects you." [7:59]

"There's another important piece here: What [does the patient] want? If this person says, 'Dori, I really don't want to do ketamine. I want to work with a plant medicine. That's what I'm feeling really called to.' I might say, 'okay, then let's explore that.' But if they're open [to either], I might say, 'why don't we start with [ketamine]?'" [15:50]

"There are very few cases that I would say, 'don't start with ketamine' unless somebody says 'I've already done ketamine' … or they say 'I don't want to do ketamine' but in most cases I'm going to recommend just start with ketamine" [23:05]

Links:

Dori on LinkedIn

Elemental Psychedelics website

Elemental Psychedelics on LinkedIn

Reflective Healing website

Reflective Healing on LinkedIn

Reflective Healing on Instagram

Fireside Project website

Previous episode: Common Psilocybin Myths & Misconceptions with Dori Lewis, LPC

Previous episode: How Psychedelics & Pharmaceuticals Can Both Aid Healing with Erica Zelfand, ND

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In the 200th episode of the Psychedelic Medicine Podcast, Ismail Lourido Ali, JD joins to discuss the future of psychedelic medicine. Ismail serves as MAPS Co-Executive Director and has been actively participating in the drug policy reform movement for over a decade, informed by half a lifetime of diverse personal experience with psychedelics and other substances.

In this conversation, Ismail explores the rapidly evolving landscape of psychedelic medicine, reflecting on the field's major milestones, challenges, and future possibilities. He discusses how public perception has shifted over the past decade, the role of state-level psychedelic reforms, and the tensions created by commercialization, overhype, and competing regulatory models. Much of the discussion focuses on the recent federal executive order related to psychedelic research and drug development, including what it may mean for FDA approval timelines, right-to-try access, rescheduling, and public health standards. Throughout, Ismail emphasizes that psychedelics are not a "silver bullet," but tools that require strong systems of care, thoughtful policy, and community support to be integrated responsibly into healthcare and society.

In this episode, you'll hear:

• How public attitudes toward psychedelics have shifted over the past decade
• Major milestones that expanded psychedelic policy reform beyond federal drug approval
• The promises and pitfalls of increased visibility, commercialization, and hype in the psychedelic field
• What the recent federal executive order on psychedelics actually does and does not do
• An explanation of right-to-try laws, FDA approval pathways, and the complexities of rescheduling psychedelic medicines
• Why maintaining rigorous evidentiary standards is essential for the long-term credibility of psychedelic medicine
• MAPS' vision for the future of psychedelic access, including regulated adult use, professional education, and community safety infrastructure
• How psychedelic policy reform could evolve to include broader systems of mental health care, crisis response, and social healing

Quotes:

"[Federal funding for psychedelic research] will only be so effective unless there is a massive reinvestment in mental health, harm reduction, and social services that actually ground—and one could say integrate—this medicine into like the continuum of care and the fabric of community that people are actually in." [25:07]

"Even though those of us in the psychedelic advocacy field do want to see drugs like MDMA and others be approved by the FDA for medical use in these controlled clinical settings… At the same time, we don't want medical access to be accelerated so much that it's at the expense of public health or consumer protection or an evidentiary standard that other drugs are being held to." [37:59]

"Medical professionals are not just prescribing things because they're approved. Many of them want to look at the evidence themselves. They want to look at the clinical trials. They want to understand 'is this the right choice for my patient?' But you can only know if [psychedelics] are being held to a comparable standard." [39:31]

"What's MAPS' vision for ten years from now or 40 years from now for that matter? I like to think of it as lots of on ramps and lots of off ramps. It's that people who are seeking access to psychedelics for any beneficial purpose—for their own treatment or healing, for their own spiritual growth, for their personal development, for their for improving of their relationships with their loved ones or with nature or with spirituality, whatever that cosmology is that they hold—that they have safe, responsible methods of doing so." [44:47]

Links:

Ismail on Instagram

Psychedelic Medicine Association

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In this episode, Dr. WaiFung Tsang, DClinPsy joins to discuss the intersection of psychedelics and neurodiversity. Dr. Tsang is a clinical research psychologist from Hong Kong, musician, and student of Shipibo curanderismo. He is the co-founder of Onaya, an organisation dedicated to bridging Indigenous tradition and Western science, and research advisor for psychedelic veteran charity Heroic Hearts Project.

In this conversation, Dr. Tsang explores the emerging intersection of psychedelics and neurodiversity, reframing neurodivergence as a context-dependent spectrum shaped by biology, culture, and lived experience. Drawing on clinical work with autistic individuals, veterans, and athletes, he discusses how psychedelic states may temporarily induce experiences similar to neurodivergence—heightening sensory processing, altering cognition, and expanding perception—and how these states manifest differently for neurodivergent individuals. The conversation highlights early anecdotal evidence and preliminary research suggesting potential benefits for social connection, attentional regulation, and emotional processing, while emphasizing the need for more rigorous studies. Dr. Tsang also underscores the importance of thoughtful accommodations in psychedelic settings, noting that many best practices for supporting neurodivergent participants—clear structure, sensory tools, and intentional environments—ultimately improve outcomes for all participants.

In this episode, you'll hear:

• How neurodiversity and neurodivergence are defined across cultural and clinical contexts
• The overlap between autistic sensory processing and psychedelic perceptual states
• Why psychedelics may shift autistic experiences toward more cognitive or structured processing
• Early findings on psychedelics and ADHD, including impacts on attention, impulsivity, and mental "chatter"
• The role of MDMA and other psychedelics in enhancing social connection and reducing social anxiety
• How group settings and shared ceremonies may uniquely benefit neurodivergent individuals
• Practical considerations for making psychedelic experiences more accessible and sensory-informed
• Why many "neurodivergent accommodations" are simply good practice for all participants

Quotes:

"Every autistic individual is so different and every autistic individual can be so vast and varied in their presentation." [8:57]

"For the autistic participants that come and join in our studies, we have a tendency to see a lot of more cognitive experiences or cognitive-based experiences." [15:57]

"One thing we have been finding is especially people who are autistic can benefit more from the community aspect within psychedelic experiences." [20:05]

"[In Shipibo ceremonies] there's no touching, no talking—it's very autistic friendly. You get to be in your own space. You get to be together but not be together." [35:16]

Links:

Dr. Tsang on Instagram

Dr. Tsang on LinkedIn

Onaya website

Onaya Science website

Onaya on Instagram

Onaya on LinkedIn

United Freedom Collective on Instagram

United Freedom Collective on Spotify

Heroic Hearts Project website

Psychedelic Medicine Association

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In this episode Amy Della Rocca, PMHNP joins to discuss Spravato, the FDA-approved prescription esketamine nasal spray, and its place in the field of psychedelic medicine. Amy is a psychiatric nurse practitioner and the Clinical Director of Marpa, a Spravato treatment center in New York.

In this conversation, Amy offers a grounded and practical look at Spravato as one of the most accessible forms of psychedelic medicine currently available, especially for patients with treatment-resistant depression who may be priced out of intravenous or intramuscular ketamine treatments. She explains how insurance coverage, prior authorizations, and the 2025 shift allowing Spravato to be used as monotherapy have expanded access, while also walking through what treatment actually looks like in practice - from REMS monitoring and nasal spray administration to maintenance schedules and the importance of outside therapeutic support. Throughout, Amy emphasizes that Spravato can produce a wide spectrum of psychedelic effects, that it should not be dismissed as a "lesser" medicine because it is FDA-approved or pharmaceutical, and that the most effective treatment happens in a relational container that balances medical safety, emotional support, and realistic expectations about what the medicine can and cannot do.

In this episode, you'll hear:

• What Spravato is and how it differs from other forms of ketamine treatment
• How insurance coverage, Medicaid, and copay assistance can make psychedelic care more financially accessible
• Which two diagnoses Spravato is approved to treat
• Why the 2025 approval of Spravato as a monotherapy meaningfully changed patient eligibility
• What a typical Spravato session looks like, including dosing, REMS monitoring, and maintenance treatment
• Why therapy, integration support, and external community can strongly influence treatment outcomes
• How patients' experiences can range from subtle relaxation to deeply psychedelic states
• Why stigma within psychedelic spaces can invalidate ketamine experiences - and why Amy argues that needs to change
• What makes a patient a good candidate for Spravato treatment
• How clinicians can carefully work with complex cases, including suicidality, trauma histories, and bipolar depression

Quotes:

"Generally we have Medicaid covering [Spravato treatments]. We have no co-pays on that or maybe it's a five-dollar co-pay. With some insurances, if there's a big deductible, they will have to pay the deductible like other treatments." [6:38]

"In 2025, the FDA changed that requirement [to be on an antidepressant to receive Spravato treatments]. And now Spravato is… approved for monotherapy. So, as you know, so many of the people that are coming to us are not taking daily antidepressants because they've had terrible side effects. Or… they've felt worse, it increased their [suicidal ideation] or, you know, whatever it was. And so to have them still have to take one just felt like the wrong thing to do." [8:34]

"I would say 30% of the patients continue [regular Spravato treatments] on some level—40% maybe of maintenance. And that can be every two weeks; it can be every week. There are plenty of folks that find that the glutamate activity of this medicine helps them more than anything they've ever taken and so they end up tapering off of other meds and continue to get weekly sessions with us." [14:28]

"This treatment feels, in a way, like a half-treatment without outside therapy" [15:25]

Links:

Amy on LinkedIn

Marpa Minds website

Journey Clinical website

Psychedelic Medicine Association Course: Managing Medical Risk in Patients Seeking Psilocybin Therapy

Previous episode: Ending Pill Shaming: How Psychedelics and Pharmaceuticals Can Both Support Healing with Erica Zelfand, ND

Previous episode: Ketamine Therapy Explained: The Science Behind Mental Health Treatment with Dr. Jason Wallach

Psychedelic Medicine Association

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In this episode, Michelle Weiner, DO, MPH returns to share her expertise on low-dose ketamine for chronic pain. Dr. Weiner is double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation. She is founder of Neuropain Health delivering personalized integrative care treating the root cause of pain and suffering, both physical and emotional, using a multidisciplinary biopsychosocial approach with many years of clinical experience with ketamine-assisted therapy.

In this conversation, Dr. Weiner reframes chronic pain as more than a symptom of tissue damage, describing it instead as a complex sensory and emotional experience shaped by the brain, nervous system, and a person's broader life context. She explains how chronic pain can become entrenched through maladaptive neural network patterns, fear, stress, and identity-level beliefs, and argues that effective treatment must move beyond symptom suppression toward a biopsychosocial model that addresses suffering, function, and quality of life. Drawing on her clinical work, Dr. Weiner discusses how low-dose ketamine, when paired with preparation, integration, pain reprocessing therapy, somatic work, and functional movement, may help create a window of neuroplasticity that allows patients to interrupt rigid pain patterns and reconnect with their own capacity for healing.

In this episode, you'll hear:

• How Dr. Weiner understands chronic pain
• The "triple network model" of neuropsychiatric conditions and how Dr. Weiner applies this to thinking about chronic pain
• Why imaging, injections, and medications often fall short once pain has become chronic and centrally mediated
• The gate control theory of pain and how this relates to possible mechanisms of ketamine treatments of pain
• How ketamine may support chronic pain treatment by creating a temporary window of neuroplasticity that can be used for deeper therapeutic change
• What pain reprocessing therapy is and why Dr. Weiner sees it as a first-line intervention for many chronic pain conditions
• Patient stories from Dr. Weiner's practice where belief change was a key component of healing pain

Quotes:

"Over time, when [pain] becomes chronic, it's no longer trying to alter the physical body, it's actually trying to reprocess what's happening in the brain." [3:47]

"Ketamine for me started to become more interesting because I realized that this wind-up phenomenon that is so responsible for a lot of people's chronic pain can actually start to be reversed when we start using medications [like ketamine] that can change the balance of glutamate and GABA [neurotransmitters]." [14:26]

"So I just started to think, how can we use the lowest dose of ketamine to create neuroplasticity, guide them in a way that they're able to move and shift the story, and then that's how you can create long term change. [18:51]

"The key is to understand that we are our own healers. If we're not involved in actively participating in our treatment, then we're relying on someone else outside of us and that's not really a long term plan." [29:20]

"More with ketamine is definitely not better. When people feel so disconnected and so separate from themselves, they can experience more fear. And I think that's important to have that sweet spot where they're able to get that time out. They're not really feeling their pain, they're not in their ordinary mind and their conscious thoughts and they're able to have the brain connect in a different way and experience things differently, which then creates hope and allows them to really wake up and say, 'oh, there there are other options out here for me.'" [30:11]

Links:

Dr. Weiner's recent article "Treating chronic pain with low dose ketamine and adjunct therapies within a biopsychosocial approach: a case series"

Dr. Weiner's website: Neuropain Health

Dr. Weiner on Instagram

Dr. Weiner on LinkedIn

Previous episode: Ketamine-Assisted Psychotherapy for Chronic Pain with Michelle Weiner, DO, MPH

Psychedelic Medicine Association

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